Myth: The people who talk about it don't do it. Studies have found that more than 75% of all completed suicides did things in the few weeks or months prior to their deaths to indicate to others that they were in deep despair. Anyone expressing suicidal feelings needs immediate attention.

Myth: Anyone who tries to kill himself has got to be crazy. Perhaps 10% of all suicidal people are psychotic or have delusional beliefs about reality. Most suicidal people suffer from the recognized mental illness of depression; but many depressed people adequately manage their daily affairs. The absence of craziness does not mean the absence of suicide risk.

Those problems weren't enough to commit suicide over, is often said by people who knew a completed suicide. You cannot assume that because you feel something is not worth being suicidal about, that the person you are with feels the same way. It is not how bad the problem is, but how badly it's hurting the person who has it.

Remember: suicidal behavior is a cry for help.

Myth: If a someone is going to kill himself, nothing can stop him. The fact that a person is still alive is sufficient proof that part of him wants to remain alive. The suicidal person is ambivalent -- part of him wants to live and part of him wants not so much death as he wants the pain to end. It is the part that wants to live that tells another I feel suicidal. If a suicidal person turns to you it is likely that he believes that you are more caring, more informed about coping with misfortune, and more willing to protect his confidentiality. No matter how negative the manner and content of his talk, he is doing a positive thing and has a positive view of you.

Be willing to give and get help sooner rather than later.

Suicide prevention is not a last minute activity. All textbooks on depression say it should be reached as soon as possible. Unfortunately, suicidal people are afraid that trying to get help may bring them more pain: being told they are stupid, foolish, sinful, or manipulative; rejection; punishment; suspension from school or job; written records of their condition; or involuntary commitment. You need to do everything you can to reduce pain, rather than increase or prolong it. Constructively involving yourself on the side of life as early as possible will reduce the risk of suicide.

Listen.

Give the person every opportunity to unburden his troubles and ventilate his feelings. You don't need to say much and there are no magic words. If you are concerned, your voice and manner will show it. Give him relief from being alone with his pain; let him know you are glad he turned to you. Patience, sympathy, acceptance. Avoid arguments and advice giving.

ASK: Are you having thoughts of suicide?

Myth: Talking about it may give someone the idea. People already have the idea; suicide is constantly in the news media. If you ask a despairing person this question you are doing a good thing for them: you are showing him that you care about him, that you take him seriously, and that you are willing to let him share his pain with you. You are giving him further opportunity to discharge pent up and painful feelings. If the person is having thoughts of suicide, find out how far along his ideation has progressed.

If the person is acutely suicidal, do not leave him alone.

If the means are present, try to get rid of them. Detoxify the home.

Urge professional help.

Persistence and patience may be needed to seek, engage and continue with as many options as possible. In any referral situation, let the person know you care and want to maintain contact.

No secrets.

It is the part of the person that is afraid of more pain that says Don't tell anyone. It is the part that wants to stay alive that tells you about it. Respond to that part of the person and persistently seek out a mature and compassionate person with whom you can review the situation. (You can get outside help and still protect the person from pain causing breaches of privacy.) Do not try to go it alone. Get help for the person and for yourself. Distributing the anxieties and responsibilities of suicide prevention makes it easier and much more effective.

From crisis to recovery.

Most people have suicidal thoughts or feelings at some point in their lives; yet less than 2% of all deaths are suicides. Nearly all suicidal people suffer from conditions that will pass with time or with the assistance of a recovery program. There are hundreds of modest steps we can take to improve our response to the suicidal and to make it easier for them to seek help. Taking these modest steps can save many lives and reduce a great deal of human suffering.

WARNING SIGNS

Conditions associated with increased risk of suicide

Death or terminal illness of relative or friend.

Divorce, separation, broken relationship, stress on family.

Loss of health (real or imaginary).

Loss of job, home, money, status, self-esteem, personal security.

Alcohol or drug abuse.

Depression. In the young depression may be masked by hyperactivity or acting out behavior. In the elderly it may be incorrectly attributed to the natural effects of aging. Depression that seems to quickly disappear for no apparent reason is cause for concern. The early stages of recovery from depression can be a high risk period. Recent studies have associated anxiety disorders with increased risk for attempted suicide.

Emotional and behavioral changes associated with suicide

Overwhelming Pain: pain that threatens to exceed the person's pain coping capacities. Suicidal feelings are often the result of longstanding problems that have been exacerbated by recent precipitating events. The precipitating factors may be new pain or the loss of pain coping resources.

Hopelessness: the feeling that the pain will continue or get worse; things will never get better.

Powerlessness: the feeling that one's resources for reducing pain are exhausted.

Difficult times: holidays, anniversaries, and the first week after discharge from a hospital; just before and after diagnosis of a major illness; just before and during disciplinary proceedings. Undocumented status adds to the stress of a crisis.

Suicidal Behavior

Previous suicide attempts, mini-attempts.

Explicit statements of suicidal ideation or feelings.

Development of suicidal plan, acquiring the means, rehearsal behavior, setting a time for the attempt.

Self-inflicted injuries, such as cuts, burns, or head banging.

Reckless behavior. (Besides suicide, other leading causes of death among young people in New York City are homicide, accidents, drug overdose, and AIDS.) Unexplained accidents among children and the elderly.

Making out a will or giving away favorite possessions.

Inappropriately saying goodbye.

Verbal behavior that is ambiguous or indirect: I'm going away on a real long trip., You won't have to worry about me anymore., I want to go to sleep and never wake up., I'm so depressed, I just can't go on., Does God punish suicides?, Voices are telling me to do bad things., requests for euthanasia information, inappropriate joking, stories or essays on morbid themes.

A WARNING ABOUT WARNING SIGNS

The majority of the population at any one time does not have many of the warning signs and has a lower suicide risk rate. But a lower rate in a larger population is still a lot of people - and many completed suicides had only a few of the conditions listed above. In a one person to another person situation, all indications of suicidality need to be taken seriously.

Crisis intervention hotlines that accept calls from the suicidal, or anyone who wishes to discuss a problem, are (in New York City) The Samaritans at 212-673-3000 and Helpline at 212-532-2400.